Nurse Case Manager Specialist - Evernorth - Northwest Georgia (Finance)

Evernorth Workplace Care offers health care delivery services along with population health and health coaching solutions, conducted in person. Our mission is to deliver proactive, personalized, and holistic patient care and coaching by acting on health data and insights to improve the overall health and wellness of our clients' employees, and those they care about most, by providing access to high quality, affordable services where they work and live.

Our Evernorth Workplace Care solution isn't a one-size-fits-all model. Using data-driven insights, we'll customize a solution that addresses your organization's most pressing needs-creating a more affordable, predictable, and simple health care experience.

Evernorth Workplace Care - Personalized Care Where You Are

• Provide advanced professional input to complex Nurse Case Management assignments/projects.

• Plan, implement, and evaluate appropriate health care services in conjunction with the physician treatment plan.

• Handle more complex, high acuity cases, and/or account sensitive cases involving largest reserves.

• Utilize clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members.

• Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.

• Manage own caseload and coordinate all assigned cases.

• Utilize in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.

• Collaborates with customer in creation of care plan and documents plan in medical management system.

• Partners with each customer to establish goals and interventions to meet the customer's needs.
• Establishes plan of care in conjunction with the customer and provider then document into a medical management system.
• Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
• Empowers customers with skills to enhance interaction with their providers.
• Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
• Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer's provider and other Cigna Medical Management programs to provide whole-person health support.
• Tracks daily activities to trend volume and outcomes.
• Follows standard operating procedures.
• Toggles between multiple systems and applications.
• Research relevant topics in health promotion and disease prevention, as required for specific customers.
• Prioritizes work to meet commitments aligned with organizational goals.
• Understands and adheres to Case Management performance measures to deliver on key results.
• Completes training within the communicated time limit as required per role.
• Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Completion of Medical Director reviews which focuses on care and case management questions and opportunities that are related to cost and quality impacts, plan or care, lack of adequate treatment plan, and readmissions.
• Client specific for team collaboration in assisting customers with biometric incentive, Disability coaching incentive, care path completion, and any other condition specific programs.

What we expect from you :

• Active and unrestricted RN license in respective state, with ability to maintain active licensure is required.

• Strong Clinical skills with at least 3 or more years of nursing experience in bedside nursing

• At least 1 or more years of Case Management experience

• Current ACLS/BLS/CPR/AED Certification

• Passion for health improvement

• Ability to work autonomously, only requiring "expert" level technical support from others.

• Proven administrative abilities, with strong computer and software application skills.

Bonus points for :

• Chronic Disease Management experience

• Certified Case Manager

• Customer-centric focus

• Experience working in a telephonic capacity

This role is remote but must live in Northwest Georgia to attend trainings and meetings in the health center.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 76,600 - 127,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.